Advancing arbovirus diagnosis in Brazil: strengthening diagnostic strategies and public health data collection.

BACKGROUND: The last five decades have seen a surge in viral outbreaks, particularly in tropical and subtropical regions like Brazil, where endemic arboviruses such as Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) pose significant threats. However, current diagnostic strategies exhibit limitations, leading to gaps in infection screening, arbovirus differential diagnoses, DENV serotyping, and life-long infection tracking. This deficiency impedes critical information availability regarding an individual's current infection and past infection history, disease risk assessment, vaccination needs, and policy formulation. Additionally, the availability of point-of-care diagnostics and knowledge regarding immune profiles at the time of infection are crucial considerations. OBJECTIVES: This review underscores the urgent need to strengthen diagnostic methods for arboviruses in Brazil and emphasizes the importance of data collection to inform public health policies for improved diagnostics, surveillance, and policy formulation. METHODS: We evaluated the diagnostic landscape for arboviral infections in Brazil, focusing on tailored, validated methods. We assessed diagnostic methods available for sensitivity and specificity metrics in the context of Brazil. RESULTS: Our review identifies high-sensitivity, high-specificity diagnostic methods for arboviruses and co-infections. Grifols transcription-mediated amplification assays are recommended for DENV, CHIKV, and ZIKV screening, while IgG/IgM ELISA assays outperform Rapid Diagnostic Tests (RDTs). The Triplex real-time RT-PCR assay is recommended for molecular screening due to its sensitivity and specificity. CONCLUSION: Enhanced diagnostic methods, on-going screening, and tracking are urgently needed in Brazil to capture the complex landscape of arboviral infections in the country. Recommendations include nationwide arbovirus differential diagnosis for DENV, ZIKV, and CHIKV, along with increased DENV serotyping, and lifelong infection tracking to combat enduring viral threats and reduce severe presentations.

Advancing arbovirus diagnosis in Brazil: strengthening diagnostic strategies and public health data collection

Abstract Background The last five decades have seen a surge in viral outbreaks, particularly in tropical and subtropical regions like Brazil, where endemic arboviruses such as Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) pose significant threats. However, current diagnostic strategies exhibit limitations, leading to gaps in infection screening, arbovirus differential diagnoses, DENV serotyping, and life-long infection tracking. This deficiency impedes critical information availability regarding an individual's current infection and past infection history, disease risk assessment, vaccination needs, and policy formulation. Additionally, the availability of point-of-care diagnostics and knowledge regarding immune profiles at the time of infection are crucial considerations. Objectives This review underscores the urgent need to strengthen diagnostic methods for arboviruses in Brazil and emphasizes the importance of data collection to inform public health policies for improved diagnostics, surveillance, and policy formulation. Methods We evaluated the diagnostic landscape for arboviral infections in Brazil, focusing on tailored, validated methods. We assessed diagnostic methods available for sensitivity and specificity metrics in the context of Brazil. Results Our review identifies high-sensitivity, high-specificity diagnostic methods for arboviruses and co-infections. Grifols transcription-mediated amplification assays are recommended for DENV, CHIKV, and ZIKV screening, while IgG/IgM ELISA assays outperform Rapid Diagnostic Tests (RDTs). The Triplex real-time RT-PCR assay is recommended for molecular screening due to its sensitivity and specificity. Conclusion Enhanced diagnostic methods, on-going screening, and tracking are urgently needed in Brazil to capture the complex landscape of arboviral infections in the country. Recommendations include nationwide arbovirus differential diagnosis for DENV, ZIKV, and CHIKV, along with increased DENV serotyping, and lifelong infection tracking to combat enduring viral threats and reduce severe presentations.

Cross-cultural adaptation of four instruments to measure stigma towards people with mental illness and substance use problems among primary care professionals in Chile.

Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.

A Health Technician-delivered Brief Intervention linked to AUDIT for reduction of alcohol use in Chilean primary care: a randomized controlled trial.

BACKGROUND: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .

Neuropsychiatric Genetics of Psychosis in the Mexican Population: A Genome-Wide Association Study Protocol for Schizophrenia, Schizoaffective, and Bipolar Disorder Patients and Controls.

No large-scale genome-wide association studies (GWASs) of psychosis have been conducted in Mexico or Latin America to date. Schizophrenia and bipolar disorder in particular have been found to be highly heritable and genetically influenced. However, understanding of the biological basis of psychosis in Latin American populations is limited as previous genomic studies have almost exclusively relied on participants of Northern European ancestry. With the goal of expanding knowledge on the genomic basis of psychotic disorders within the Mexican population, the National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), the Harvard T.H. Chan School of Public Health, and the Broad Institute's Stanley Center for Psychiatric Research launched the Neuropsychiatric Genetics Research of Psychosis in Mexican Populations (NeuroMex) project to collect and analyze case-control psychosis samples from 5 states across Mexico. This article describes the planned sample collection and GWAS protocol for the NeuroMex study. The 4-year study will span from April 2018 to 2022 and aims to recruit 9,208 participants: 4,604 cases and 4,604 controls. Study sites across Mexico were selected to ensure collected samples capture the genomic diversity within the Mexican population. Blood samples and phenotypic data will be collected during the participant interview process and will contribute to the development of a local biobank in Mexico. DNA extraction will be done locally and genetic analysis will take place at the Broad Institute in Cambridge, MA. We will collect extensive phenotypic information using several clinical scales. All study materials including phenotypic instruments utilized are openly available in Spanish and English. The described study represents a long-term collaboration of a number of institutions from across Mexico and the Boston area, including clinical psychiatrists, clinical researchers, computational biologists, and managers at the 3 collaborating institutions. The development of relevant data management, quality assurance, and analysis plans are the primary considerations in this protocol article. Extensive management and analysis processes were developed for both the phenotypic and genetic data collected. Capacity building, partnerships, and training between and among the collaborating institutions are intrinsic components to this study and its long-term success.

Diversity matters: opportunities in the study of the genetics of psychotic disorders in low- and middle-income countries in Latin America.

Lack of diversity regarding genetic and environmental backgrounds weakens the generalization and clinical applicability of research findings on psychotic disorders. Notably, Latin Americans have been generally neglected in genetic studies, comprising less than 2% of genome-wide association study samples. But Latin American populations represent a unique opportunity for research, given the exceptionally high ethnic admixture of this group. Increasing genetic diversity is essential to improve the fine mapping of known regions associated with psychotic disorders, discover novel genetic associations, and replicate studies. Additionally, Latin America is characterized by massive social, political, and economic inequalities, all known risk factors for mental health issues, including psychotic disorders. This article aims to 1) discuss the challenges and advantages of studying Latin America's particular genetic makeup and environmental context; 2) review previous studies conducted in the region; and 3) describe three Latin American research initiatives in progress: the Neuropsychiatric Genetics of Psychosis in Mexican Populations (NeuroMEX), the Paisa, and the Latin American Network for the Study of Early Psychosis (ANDES) studies.

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett's esophagus?

OBJECTIVE: to evaluate esophageal dysmotility (ED) and the extent of Barrett's esophagus (BE) before and after laparoscopic Nissen fundoplication (LNF) in patients previously diagnosed with BE and ED. METHODS: twenty-two patients with BE diagnosed by upper gastrointestinal (GI) endoscopy with biopsies and ED diagnosed by conventional esophageal manometry (CEM) were submitted to a LNF, and followed up with clinical evaluations, upper GI endoscopy with biopsies and CEM, for a minimum of 12 months after the surgical procedure. RESULTS: : sixteen patients were male (72.7%) and six were females (27.3%). The mean age was 55.14 (± 15.52) years old. and the mean postoperative follow-up was 26.2 months. The upper GI endoscopy showed that the mean length of BE was 4.09 cm preoperatively and 3.91cm postoperatively (p=0.042). The evaluation of esophageal dysmotility through conventional manometry showed that: the preoperative median of the lower esophageal sphincter resting pressure (LESRP) was 9.15 mmHg and 13.2 mmHg postoperatively (p=0.006). The preoperative median of the esophageal contraction amplitude was 47.85 mmHg, and 57.50 mmHg postoperatively (p=0.408). Preoperative evaluation of esophageal peristalsis showed that 13.6% of the sample presented diffuse esophageal spasm and 9.1% ineffective esophageal motility. In the postoperative, 4.5% of patients had diffuse esophageal spasm, 13.6% of aperistalsis and 22.7% of ineffective motor activity (p=0.133). CONCLUSION: LNF decreased the BE extension, increased the LES resting pressure, and increased the amplitude of the distal esophageal contraction; however, it was unable to improve ED.

Potential pregnancy days lost: an innovative measure of gestational age.

In Brazil, the excess of interventions that anticipate childbirth, such as cesarean sections and labor inductions, has resulted in the shortening of pregnancy, with negative consequences on maternal-infant outcomes. This commentary presents a novel way to measure gestational age: the continuous variable "Potential pregnancy days lost." Using data from the Live Birth Information System (SINASC), we counted the missing days between the period until childbirth and the average duration of pregnancy (280 days), or the lost weeks. This measure can be used as an outcome variable (socioeconomic-demographic characteristics of the mother, type of childbirth, financing, etc.) or exposure variable (for neonatal, infant, and maternal outcomes). The indicator can be used in municipal and national cohorts and intervention studies to analyze hospitals and regions. We discuss the limits and scope of gestational age measures and, given their inaccuracies, the importance of studying their trends.

Does the nissen fundoplication procedure improve esophageal dysmotility in patients with barrett's esophagus? / A fundoplicatura a nissen melhora a dismotilidade esofágica em pacientes com esôfago de barrett?

ABSTRACT Objective: to evaluate esophageal dysmotility (ED) and the extent of Barrett's esophagus (BE) before and after laparoscopic Nissen fundoplication (LNF) in patients previously diagnosed with BE and ED. Methods: twenty-two patients with BE diagnosed by upper gastrointestinal (GI) endoscopy with biopsies and ED diagnosed by conventional esophageal manometry (CEM) were submitted to a LNF, and followed up with clinical evaluations, upper GI endoscopy with biopsies and CEM, for a minimum of 12 months after the surgical procedure. Results : sixteen patients were male (72.7%) and six were females (27.3%). The mean age was 55.14 (± 15.52) years old. and the mean postoperative follow-up was 26.2 months. The upper GI endoscopy showed that the mean length of BE was 4.09 cm preoperatively and 3.91cm postoperatively (p=0.042). The evaluation of esophageal dysmotility through conventional manometry showed that: the preoperative median of the lower esophageal sphincter resting pressure (LESRP) was 9.15 mmHg and 13.2 mmHg postoperatively (p=0.006). The preoperative median of the esophageal contraction amplitude was 47.85 mmHg, and 57.50 mmHg postoperatively (p=0.408). Preoperative evaluation of esophageal peristalsis showed that 13.6% of the sample presented diffuse esophageal spasm and 9.1% ineffective esophageal motility. In the postoperative, 4.5% of patients had diffuse esophageal spasm, 13.6% of aperistalsis and 22.7% of ineffective motor activity (p=0.133). Conclusion: LNF decreased the BE extension, increased the LES resting pressure, and increased the amplitude of the distal esophageal contraction; however, it was unable to improve ED.

RESUMO Objetivo: avaliar a dismotilidade esofágica (DE) e a extensão do esôfago de Barrett (EB) antes e depois da fundoplicatura laparoscópica a Nissen (FLN) em pacientes previamente diagnosticados com EB e DE. Método: vinte e dois pacientes com EB diagnosticada por endoscopia digestiva alta (EDA) com biópsias e DE diagnosticada por manometria esofágica convencional (MEC) foram submetidos a FLN, e acompanhados por avaliações clínicas, endoscopia digestiva alta com biópsias e MEC, por no mínimo 12 meses após o procedimento cirúrgico. Resultados: dezesseis pacientes eram do sexo masculino (72,7%) e seis do feminino (27,3%). A média de idade foi de 55,14 (± 15,52) anos e o seguimento pós-operatório médio foi de 26,2 meses. A endoscopia digestiva alta mostrou que o comprimento médio do EB foi de 4,09 cm no pré-operatório e 3,91 cm no pós-operatório (p = 0,042). A avaliação da dismotilidade esofágica por meio da manometria convencional mostrou que a mediana pré-operatória da pressão de repouso do esfíncter esofágico inferior (PREEI) foi de 9,15 mmHg, e de 13,2 mmHg no pós-operatório (p = 0,006). A mediana pré-operatória da amplitude de contração esofágica foi de 47,85 mmHg, e de 57,50 mmHg no pós-operatório (p = 0,408). A avaliação pré-operatória do peristaltismo esofágico mostrou que 13,6% da amostra apresentava espasmo esofágico difuso e 9,1%, motilidade esofágica ineficaz. No pós-operatório, 4,5% dos pacientes apresentaram espasmo esofágico difuso, 13,6% de aperistalse e 22,7% de atividade motora ineficaz (p = 0,133). Conclusões: a FLN diminuiu a extensão do EB, aumentou a pressão de repouso do EEI e aumentou a amplitude da contração esofágica distal; no entanto, não foi capaz de melhorar a DE.

Potential pregnancy days lost: an innovative measure of gestational age / Dias potenciais de gravidez perdidos: uma medida inovadora da idade gestacional

ABSTRACT In Brazil, the excess of interventions that anticipate childbirth, such as cesarean sections and labor inductions, has resulted in the shortening of pregnancy, with negative consequences on maternal-infant outcomes. This commentary presents a novel way to measure gestational age: the continuous variable "Potential pregnancy days lost." Using data from the Live Birth Information System (SINASC), we counted the missing days between the period until childbirth and the average duration of pregnancy (280 days), or the lost weeks. This measure can be used as an outcome variable (socioeconomic-demographic characteristics of the mother, type of childbirth, financing, etc.) or exposure variable (for neonatal, infant, and maternal outcomes). The indicator can be used in municipal and national cohorts and intervention studies to analyze hospitals and regions. We discuss the limits and scope of gestational age measures and, given their inaccuracies, the importance of studying their trends.

RESUMO No Brasil, o excesso de intervenções que antecipam o parto, como cesarianas e induções, tem resultado no encurtamento da gestação, com consequências negativas nos desfechos materno-infantis. Neste comentário apresentamos uma medida inovadora da idade gestacional que estamos desenvolvendo: a variável contínua "dias potenciais de gravidez perdidos". Utilizando dados do Sistema de Informações de Nascidos Vivos, contamos, quando possível, os dias faltantes entre o período até o nascimento e a duração média da gestação (280 dias), ou então as semanas perdidas. Essa medida pode ser usada como variável desfecho (de características socioeconômico-demográficos da mãe, do tipo de parto, de financiamento etc.) ou de exposição (para desfechos neonatais, infantis e maternos). O indicador pode ser usado em coortes municipais e nacionais e em estudos de intervenção, para analisar hospitais e territórios. Discutimos os limites e alcances das medidas de idade gestacional e, diante de suas imprecisões, a importância de estudar suas tendências.

The Effect of Sleeve Gastrectomy on the Hormonal Profile of Patients with Polycystic Ovary Syndrome.

PURPOSE: To prospectively evaluate the hormonal profile and weight loss of women with obesity and PCOS submitted to sleeve gastrectomy (SG). METHODS: A Prospective study carried out at the Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil, in 2018, where 18 patients with PCOS, whose age varied from 18 to 40 years, with an indication for bariatric surgery were evaluated. Plasma estradiol (E2), fasting insulin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured prior to bariatric surgery and 3 months after surgery. The LH/FSH ratio and BMI of the study participants were also calculated. RESULTS: Postoperative E2 levels were higher (preoperative mean of 63.4 pg/dL versus postoperative mean of 91.0 pg/dL), with no statistical significance then (p = 0.139). It was observed, at the postoperative period, statistically significant decreases in mean fasting insulin levels (24.4 mIU/mL vs. 9.0 mIU/mL; p < 0.001), LH levels (7.2 vs. 4.5; p = 0.047), and an inverted LH/FSH ratio (1.5 vs. 0.9; p = 0.008); relevant weight loss occurred (mean BMI, 40.5 kg/m2 vs. 33.4 kg/m2; p < 0.001). CONCLUSION: Relevant changes in the hormone profile and significant alterations in the gonadotropic and insulin patterns were seen. In addition to satisfactory weight loss, the observed endocrine alterations revealed an internal environment that was more homeostatic and conducive to reproduction, indicating that SG was able to produce attractive physiological outcomes for women with PCOS.

Dedifferentiated liposarcoma of the gallbladder: first reported case.

BACKGROUND: Liposarcoma of the gallbladder is an extremely rare sarcoma, with only five cases reported in the literature according to our knowledge. CASE PRESENTATION: A 71-year-old woman was referred to the Surgical Oncology Division of Napoleão Laureano Hospital (João Pessoa, PB, Brazil) due to a solid mass at the right side of the abdomen and fever, with no signs of jaundice. Abdominal ultrasonography and computed tomography (CT) evidenced an extensive gallbladder lobular formation adhered to the inferior border of the right hepatic lobe and cholelithiasis. The CT report suggested gallbladder liposarcoma. A cholecystectomy associated with resection of segments IV-B and V of the liver were performed. Intraoperative frozen sections were compatible with gallbladder sarcoma. Anatomopathological examination and immunohistochemistry confirmed dedifferentiated liposarcoma with foci of heterologous leiomyosarcomatous differentiation and undifferentiated fusocellular areas of high histological grade. CONCLUSION: This is the first case of dedifferentiated liposarcoma of the gallbladder to be reported.

Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America.

Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.

A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

AIM: To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care. DESIGN: A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20). SETTING: A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated. PARTICIPANTS: A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized. INTERVENTION AND COMPARISON: ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406). MEASUREMENTS: Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up. FINDINGS: Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47). CONCLUSION: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

Incidência e características dos recém-nascidos de peso insuficiente de uma coorte de neonatos de um hospital público regional de área metropolitana / Incidence and characteristics of insufficient birth weight newborns from a cohort of neonates in a public regional hospital of a metropolitan area

Introdução: o peso de nascimento é um indicador utilizado na avaliação do crescimento intrauterino (IU) além de um marcador de risco de morbimortalidade. Já existe um número elevado de pesquisas sobre recém-nascidos (RN) de baixo peso (BPN), enquanto os sobre RN de peso de nascimento insuficiente (PNI) são raros, inclusive quanto às suas relações com o crescimento IU adequado ou restrito. Objetivo: estimar a incidência de peso insuficiente entre os recém-nascidos a termo e a proporção de pequenos para a idade gestacional entre os mesmos, em uma clientela urbana do SUS. Método: estudo observacional, em maternidade pública, do hospital Regional de Cotia, da região metropolitana de São Paulo que atende o SUS. Avaliou-se o universo de nascimentos vivos no último trimestre de 2009, determinando-se a proporção de RNPNI e a adequação do seu peso, segundo sexo e idade gestacional. Resultados: a incidência de PNI foi semelhante à observada no Brasil nas duas últimas décadas, correspondendo a 1/4 do total de nascimentos. A proporção de RN PIG foi pequena, afetando apenas 4,2 por cento dos RN de PNI. Em 90 por cento destes RN não se identificou patologias que explicassem o PNI. A proporção de nascimentos de partos cesáreos (47,1 por cento) entre os RN de PNI, bem como a diferença de idade gestacional que os mesmos apresentavam em relação aos RN de peso adequado, cerca de 4 dias, do ponto de vista de crescimento IU não justificariam a diferença na média de peso existente entre os dois grupos. Conclusão: a incidência de PNI foi elevada, mas apenas uma pequena proporção destes RN era PIG. Os dados indicam a necessidade de se continuar pesquisando acerca do PNI, inclusive para fornecer subsídios que possam contribuir para melhorar a política e os programas de assistência pré e peri-natal.

INTRODUCTION: birth weight is an indicator for the evaluation of intrauterine growth (IUGR) as well as a mortality risk index. There are already a large number of studies on newborns (NB) with low birth weight (LBW), while studies on those with insufficient birth weight (IB) are rare, including those related to adequate or limited intrauterine growth. OBJECTIVE: to estimate the incidence of underweight among infants born at term and the proportion of those who are small for their gestational age, within an urban clientele of the brazilian public health system, Sistema Único de Saúde, SUS. METHODS: observational study in a public maternity department of the hospital Regional de Cotia, in the metropolitan area of †São Paulo, which cares for of SUS patients. A universe of live births were evaluated in the last trimester of 2009, determining the proportion of IB infants and the adequacy of weight, based on gestational age and sex. RESULTS: the incidence of insufficient birth weight was similar to that observed in the last two decades in Brazil, corresponding to 1/4 of the total number of births. The proportion of small gestational age newborns (NB SGA) was small, affecting only 4.2% of the IB infants. In 90% of these infants no pathology was identified to explain IB. The proportion of cesarean births (47.1%) among IB newborns as well as the difference in gestational age that they had in relation to the newborns of adequate weight, around four days, from the standpoint of IUGR does not justify the difference in mean weight between the two groups. CONCLUSION: the incidence of IB was high, however only a small proportion of these infants were small for gestational age. The data indicates the need for continued research on IB, including providing incentives for the continued improvement of public policies and programs regarding pre and peri-natal care.

Birth at the health center or at home: an analysis of birthing care among the Kukamas Kukamirias women of Peru

OBJECTIVE: to describe and analyze the culture and traditions related to pregnancy, childbirth and postpartum care of the Kukama kukamiria women, living in the Peruvian Amazon, and their experiences and perceptions of care at home compared to that received at the health center. METHODS: a qualitative study based on ethnography that seeks to analyze traditional knowledge and practices of self-care, taking into account descriptions of home births attended by traditional midwives, compared to that of birth care at the health institution. RESULTS: home delivery prioritizes women's' comfort, through the use of teas, baths and specific rituals in caring for the placenta; dietary regulations and attention to environmental aspects such as temperature and lighting are built into care. At the health facilities, routine interventions include acceleration of labor with the use of drugs, vaginal cutting (episiotomy), immobilization in lithotomy position, and the disposal of the placenta as garbage; which is perceived as inadequate and aggressive. CONCLUSION: a preference for traditional care is justified based on feelings of neglect and vulnerability at institutionalized health centers, resulting from the lack of consideration by the health services for the cultural and well-being specificities of the Kukama Kukamiria women...

OBJETIVO: conhecer e descrever a cultura e tradições relacionadas à gravidez, parto e pós-parto das mulheres Kukama kukamiria, da Amazônia peruana, suas experiências de atendimento à saúde materna, tradicional e institucional, e razões de sua preferência por um ou outro sistema. MÉTODO: estudo de base etnográfica, analisando saberes e práticas de cuidado, e como são vividas nos diferentes cenários da assistência: o parto domiciliar atendido por parteira indígena, e o parto em instituição de saúde atendido por profissional treinado. RESULTADOS: o parto em casa considera o conforto da mulher, com banhos, uso de chás, preceitos alimentares e atenção a aspectos ambientais como o frio, vento, penumbra e quietude, e rituais específicos para a placenta, com base nas noções culturais de vulnerabilidade da parturiente. No posto de saúde, a exposição ao frio e umidade, rotinas como a falta de privacidade, aceleração do parto com drogas, corte da vagina, imobilização deitada durante o parto, e o descarte da placenta, são percebidas como inadequadas e agressivas. CONCLUSÃO: a preferência das pacientes pelo cuidado tradicional é justificada por se sentirem negligenciadas e vulneráveis no posto de saúde, como resultante da desconsideração de aspectos culturais e do bem-estar das parturientes, por parte dos serviços de saúde...

Birth at the health center or at home: an analysis of birthing care among the Kukamas Kukamirias women of Peru

OBJECTIVE: to describe and analyze the culture and traditions related to pregnancy, childbirth and postpartum care of the Kukama kukamiria women, living in the Peruvian Amazon, and their experiences and perceptions of care at home compared to that received at the health center. METHODS: a qualitative study based on ethnography that seeks to analyze traditional knowledge and practices of self-care, taking into account descriptions of home births attended by traditional midwives, compared to that of birth care at the health institution. RESULTS: home delivery prioritizes women's' comfort, through the use of teas, baths and specific rituals in caring for the placenta; dietary regulations and attention to environmental aspects such as temperature and lighting are built into care. At the health facilities, routine interventions include acceleration of labor with the use of drugs, vaginal cutting (episiotomy), immobilization in lithotomy position, and the disposal of the placenta as garbage; which is perceived as inadequate and aggressive. CONCLUSION: a preference for traditional care is justified based on feelings of neglect and vulnerability at institutionalized health centers, resulting from the lack of consideration by the health services for the cultural and well-being specificities of the Kukama Kukamiria women...(AU)

OBJETIVO: conhecer e descrever a cultura e tradições relacionadas à gravidez, parto e pós-parto das mulheres Kukama kukamiria, da Amazônia peruana, suas experiências de atendimento à saúde materna, tradicional e institucional, e razões de sua preferência por um ou outro sistema. MÉTODO: estudo de base etnográfica, analisando saberes e práticas de cuidado, e como são vividas nos diferentes cenários da assistência: o parto domiciliar atendido por parteira indígena, e o parto em instituição de saúde atendido por profissional treinado. RESULTADOS: o parto em casa considera o conforto da mulher, com banhos, uso de chás, preceitos alimentares e atenção a aspectos ambientais como o frio, vento, penumbra e quietude, e rituais específicos para a placenta, com base nas noções culturais de vulnerabilidade da parturiente. No posto de saúde, a exposição ao frio e umidade, rotinas como a falta de privacidade, aceleração do parto com drogas, corte da vagina, imobilização deitada durante o parto, e o descarte da placenta, são percebidas como inadequadas e agressivas. CONCLUSÃO: a preferência das pacientes pelo cuidado tradicional é justificada por se sentirem negligenciadas e vulneráveis no posto de saúde, como resultante da desconsideração de aspectos culturais e do bem-estar das parturientes, por parte dos serviços de saúde...(AU)

Incidência e características dos recém-nascidos de peso insuficiente de uma coorte de neonatos de um hospital público regional de área metropolitana / Incidence and characteristics of insufficient birth weight newborns from a cohort of neonates in a public regional hospital of a metropolitan area

Introdução: o peso de nascimento é um indicador utilizado na avaliação do crescimento intrauterino (IU) além de um marcador de risco de morbimortalidade. Já existe um número elevado de pesquisas sobre recém-nascidos (RN) de baixo peso (BPN), enquanto os sobre RN de peso de nascimento insuficiente (PNI) são raros, inclusive quanto às suas relações com o crescimento IU adequado ou restrito. Objetivo: estimar a incidência de peso insuficiente entre os recém-nascidos a termo e a proporção de pequenos para a idade gestacional entre os mesmos, em uma clientela urbana do SUS. Método: estudo observacional, em maternidade pública, do hospital Regional de Cotia, da região metropolitana de São Paulo que atende o SUS. Avaliou-se o universo de nascimentos vivos no último trimestre de 2009, determinando-se a proporção de RNPNI e a adequação do seu peso, segundo sexo e idade gestacional. Resultados: a incidência de PNI foi semelhante à observada no Brasil nas duas últimas décadas, correspondendo a 1/4 do total de nascimentos. A proporção de RN PIG foi pequena, afetando apenas 4,2 por cento dos RN de PNI. Em 90 por cento destes RN não se identificou patologias que explicassem o PNI. A proporção de nascimentos de partos cesáreos (47,1 por cento) entre os RN de PNI, bem como a diferença de idade gestacional que os mesmos apresentavam em relação aos RN de peso adequado, cerca de 4 dias, do ponto de vista de crescimento IU não justificariam a diferença na média de peso existente entre os dois grupos. Conclusão: a incidência de PNI foi elevada, mas apenas uma pequena proporção destes RN era PIG. Os dados indicam a necessidade de se continuar pesquisando acerca do PNI, inclusive para fornecer subsídios que possam contribuir para melhorar a política e os programas de assistência pré e peri-natal.(AU)

INTRODUCTION: birth weight is an indicator for the evaluation of intrauterine growth (IUGR) as well as a mortality risk index. There are already a large number of studies on newborns (NB) with low birth weight (LBW), while studies on those with insufficient birth weight (IB) are rare, including those related to adequate or limited intrauterine growth. OBJECTIVE: to estimate the incidence of underweight among infants born at term and the proportion of those who are small for their gestational age, within an urban clientele of the brazilian public health system, Sistema Único de Saúde, SUS. METHODS: observational study in a public maternity department of the hospital Regional de Cotia, in the metropolitan area of †São Paulo, which cares for of SUS patients. A universe of live births were evaluated in the last trimester of 2009, determining the proportion of IB infants and the adequacy of weight, based on gestational age and sex. RESULTS: the incidence of insufficient birth weight was similar to that observed in the last two decades in Brazil, corresponding to 1/4 of the total number of births. The proportion of small gestational age newborns (NB SGA) was small, affecting only 4.2% of the IB infants. In 90% of these infants no pathology was identified to explain IB. The proportion of cesarean births (47.1%) among IB newborns as well as the difference in gestational age that they had in relation to the newborns of adequate weight, around four days, from the standpoint of IUGR does not justify the difference in mean weight between the two groups. CONCLUSION: the incidence of IB was high, however only a small proportion of these infants were small for gestational age. The data indicates the need for continued research on IB, including providing incentives for the continued improvement of public policies and programs regarding pre and peri-natal care.(AU)